Sunday, April 18, 2010

Why?

I’m not surprised that very few of our friends and family have asked me this question. It’s not for lack of curiosity - I’m sure - but rather consideration for our privacy. In any case, medical details are far less important than outcome. Little Wallace, although still in hospital, is healthy and well today.

But a standard pregnancy lasts 40 weeks and our boy was delivered by surgery at less than 32. So… why? There is no reason why I can't answer that question here today. Kate and I feel lucky to have had the medical care that we did and I am writing this post today because it will give me a chance to recognize and acknowledge the heroes involved.

Obviously children were born healthy long before modern medicine and every pregnancy is different but I just have this one example, and in it, the ultrasound-evidence-based decision to deliver Wally undoubtedly saved his life.

I’ll try to give you the short version: In Australia it is common to get two ultrasound scans at 12 and 18 weeks of pregnancy. Kate’s scans were both good. Little Wallace was not yet named but growing fast, looking wonderful, and due in mid-May. No troubles. No further scans were needed or scheduled. Here, let me show you a prettty remarkable image: this is Wallace when Kate was just 12 weeks pregnant. (A new gimmick made available by modern ultrasound machines.)

By a stroke of fortune that still wells me up when I think of it, during a regular checkup at 28 weeks, our obstetrician decided to show-off his brand new ‘office-sized’ ultrasound machine and have a quick-peek-scan of Wally for no reason at all... literally ‘just for fun’. We now know that very few pregnant women get to have an ultrasound scan at 28 weeks in any country. There is just no need. But as the doc glanced at the image on his screen that morning his light-hearted persona changed before our eyes for the first time in the months that we had known him. If you had been there, you would have been spooked like I was. We were sent immediately to the ‘pros’ for high-resolution images at the Maternal Fetal Medicine centre at Mater Hospital – just a short walk away - where, after much discussion between three experts, it was decided that Wallace was comfortable and fine at the moment but had a rare ‘umbilical cord issue’ that no one there had actually ever seen with their own eyes before: a ‘large cord hematoma’. And they were worried. Truthfully, I think they were also a bit excited to have the chance to see something quire rare and 'dangerous' alongside an apparently healthy baby. But more importantly to me... they were worried.

Kate and Wallace were put on a regular ultrasound scanning schedule. We were told that Wallace would definitely exit by C-section because ‘ordinary’ delivery was far too hazardous for him, and he would be out at 36 weeks at the latest because leaving him in there any longer would be careless and foolish. The doctors were weighing the benefits of prolonging pregnancy versus the risks of potential umbilical cord rupture which Wallace would not survive. The little guy was, in a sense, floating next to a ticking time bomb. I hate to think of it, even now. The second major concern was about stress on Wally’s heart which ultimately leads to heart failure. But this they could monitor and Wallace would need to be ‘watched very carefully’ for the rest of the pregnancy for signs of ‘trouble’. So far, his heart appeared to be doing just fine.

There was no rhyme or reason to this ‘complication’, we were told, no way to foresee it or prevent it. Statistically speaking, it would never happen again. It was just terrible luck; like being struck by lightning. The weeks that followed were difficult for us as we became regular visitors to the hospital for scans and pretty much always feared the worst. Being in the profession that I’m in, of course I found the relevant medical literature. Documented cases of such ‘hematomas’ were indeed rare. And the reports were full of still-births and very serious complications. Kate and I were terrified. In all honesty, I sometimes wonder how a smart doctor can ever summon up the courage to breathe air or touch anything. There are literally thousands upon thousands of unique things that can ‘go wrong’ with a human being. The blue prints of you and I would make those of the international space station look like a children’s book. But the vast majority of potential problems ‘never’ happen so we need not worry or even know about them. Physicians on the other hand memorize lists of such problems, and keep memorizing as new ones are discovered and added. They observe and think about these problems daily. No thanks.

Now, I’ll skip to 31 weeks. Wallace started to show early signs of becoming mildly anemic (they could see this by using an ultrasound speed gun to measure ‘blood velocity’ in one of his arteries and using plumbing equations to convert the ‘fast’ blood measure to a ‘thin’ blood measure). Although it was the first sign of a bit of stress on Wally’s heart, mild anemia is not a big deal, but if it progressed to ‘severe’ anemia, it would be followed by heart failure. His ‘blood velocity’ was carefully monitored for a few days for signs of increasing stress on his ‘ticker’ and then on the morning of his birthday the decision was made to ‘bail out’ – that was actually what they called it. Kate got less than 4 hours notice, I rushed to the hospital from work, and Wallace was born.

And he was born healthy :) So healthy in fact that I felt the doctors might have been a bit surprised – although I think they tried hard not to show it. Wally's umbilical cord was the subject of super-nerdy interest and excitement by the pros. They took pictures of it and even sent it for an ‘autopsy’. I liked seeing these high-paid experts get excited about something so strange. I have some appreciation for the enjoyment of research and discovery. Wally's case will be published in some obstetrics journal and perhaps it will someday help doctors and terrified parents elsewhere.

Before his birthday, Wallace had been fighting to 'swim', for some time, against an increasing current. And hard-to-imagine as it may now be, despite his best efforts, our boy was dangerously close to a steep and certain fall until someone quite literally ‘reached in’ with a big gloved hand and saved him. That 'someone' was actually a small team of smart men, all of whom had spent countless years learning how to save children. And that 'someone' can also mean every one of the thousands upon thousands of people responsible for the amazing advancement in medical knowledge and technology that we are now witnessing right before our eyes.

I'll leave it to you to imagine how Kate and I feel about the doctors that rescued this little guy: